TY - JOUR
T1 - Association of diabetes with outcomes in patients undergoing contemporary percutaneous coronary intervention: Pre-specified subgroup analysis from the randomized GLOBAL LEADERS study
AU - Chichareon, Ply
AU - Modolo, Rodrigo
AU - Kogame, Norihiro
AU - Takahashi, Kuniaki
AU - Chang, Chun-Chin
AU - Tomaniak, Mariusz
AU - Botelho, Roberto
AU - Eeckhout, Eric
AU - Hofma, Sjoerd
AU - Trendafilova-Lazarova, Diana
AU - Kőszegi, Zsolt
AU - Iñiguez, Andres
AU - Wykrzykowska, Joanna J.
AU - Piek, Jan J.
AU - Garg, Scot
AU - Hamm, Christian
AU - Steg, Philippe Gabriel
AU - Jüni, Peter
AU - Vranckx, Pascal
AU - Valgimigli, Marco
AU - Windecker, Stephan
AU - Onuma, Yoshinobu
AU - Serruys, Patrick W.
PY - 2020/2
Y1 - 2020/2
N2 - Background and aims: Diabetes has been well recognized as a strong predictor for adverse outcomes after percutaneous coronary intervention (PCI), however, studies in the era of drug-eluting stent and potent P2Y12 inhibitors have shown conflicting results. We aimed to assess ischemic and bleeding outcomes after contemporary PCI according to diabetic status. Methods: We studied 15,957 patients undergoing PCI for stable or acute coronary syndrome in the GLOBAL LEADERS study with known baseline diabetic status. The primary endpoint was all-cause death or new Q-wave myocardial infarction at 2 years. The secondary safety endpoint was major bleeding defined as bleeding academic research consortium (BARC) type 3 or 5. Results: A quarter of the study cohort were diabetic (4038/15,957), and these patients had a significantly higher risk of primary endpoint at 2 years compared to non-diabetics (adjusted hazard ratio [HR] 1.38; 95% confidence interval [CI] 1.17–1.63). The difference was driven by a significantly higher risk of all-cause mortality at 2 years in diabetics (adjusted HR 1.47, 95% CI 1.22–1.78). The risk of BARC 3 or 5 bleeding was comparable between the two groups (adjusted HR 1.09, 95% CI 0.86–1.39). The antiplatelet strategy (experimental versus reference strategy) had no significant effect on the rates of primary endpoint and secondary safety endpoint at 2 years in patients with and without diabetes. Conclusions: Diabetic patients had higher risk of ischemic events after PCI than non-diabetic patients, whilst bleeding risk was comparable. The outcomes of diabetic patients following PCI were not affected by the two different antiplatelet strategies.
AB - Background and aims: Diabetes has been well recognized as a strong predictor for adverse outcomes after percutaneous coronary intervention (PCI), however, studies in the era of drug-eluting stent and potent P2Y12 inhibitors have shown conflicting results. We aimed to assess ischemic and bleeding outcomes after contemporary PCI according to diabetic status. Methods: We studied 15,957 patients undergoing PCI for stable or acute coronary syndrome in the GLOBAL LEADERS study with known baseline diabetic status. The primary endpoint was all-cause death or new Q-wave myocardial infarction at 2 years. The secondary safety endpoint was major bleeding defined as bleeding academic research consortium (BARC) type 3 or 5. Results: A quarter of the study cohort were diabetic (4038/15,957), and these patients had a significantly higher risk of primary endpoint at 2 years compared to non-diabetics (adjusted hazard ratio [HR] 1.38; 95% confidence interval [CI] 1.17–1.63). The difference was driven by a significantly higher risk of all-cause mortality at 2 years in diabetics (adjusted HR 1.47, 95% CI 1.22–1.78). The risk of BARC 3 or 5 bleeding was comparable between the two groups (adjusted HR 1.09, 95% CI 0.86–1.39). The antiplatelet strategy (experimental versus reference strategy) had no significant effect on the rates of primary endpoint and secondary safety endpoint at 2 years in patients with and without diabetes. Conclusions: Diabetic patients had higher risk of ischemic events after PCI than non-diabetic patients, whilst bleeding risk was comparable. The outcomes of diabetic patients following PCI were not affected by the two different antiplatelet strategies.
KW - Coronary artery disease
KW - Diabetes
KW - Drug-eluting stents
KW - Percutaneous coronary intervention
KW - Ticagrelor
UR - http://www.scopus.com/inward/record.url?scp=85078431398&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.atherosclerosis.2020.01.002
DO - https://doi.org/10.1016/j.atherosclerosis.2020.01.002
M3 - Article
C2 - 32006758
SN - 0021-9150
VL - 295
SP - 45
EP - 53
JO - Atherosclerosis
JF - Atherosclerosis
ER -